While not a lot of research has been done on Selective Mutism (SM) due to a relatively smaller sample size and issues of misunderstanding, it is not uncommon that anxiety disorders like SM are often debated to be comorbid with Autism Spectrum Disorder (ASD). As symptoms of SM coincides with a number of behaviors, social-communication deficits, and other symptoms of ASD, it is no surprise that it may be hard to differentiate the two. This causes SM to be mislabeled, indirectly leading to serious barriers to effective treatments.
Selective Mutism is a social anxiety disorder most commonly found in children. According to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; APA, 2013, p.195), the diagnostic criteria for SM include:
Consistent failure to speak in specific social situations when there is an expectation for speaking (eg. at school), despite being able to speak in other situations (eg. at home)
The disturbance interferes with academic achievement or with social communication
The duration of the disturbance is at least 1 month
The failure to speak is not attributable to a lack of knowledge of, or unfamiliarity with, the spoken language required in the social situation
The disturbance is not better explained by a communication disturbance and does not occur exclusively during the course of Autism Spectrum Disorder, Schizophrenia, or any other psychotic disorder
With the knowledge of the diagnostic criteria of SM in mind, individuals with SM will most likely display symptoms and behaviors such as lack of eye contact, hiding, tantrums, meltdowns, avoidance, and anxiety towards specific situations. Thus, these behaviors can be understood as a method of self-protection for individuals with SM during an experience of intense anxiety. They may be worried about others hearing their voices, asking them questions, and forcing them to speak. This results in a vicious cycle of increased anxiety which will likely lead to more internal turmoil. Yet, it is crucial to understand that individuals with SM do speak, respond, and interact normally without trouble in social settings that are relatively more comfortable. As such, some are able to speak on the phone because face-to-face components, such as eye-contact, are removed.
On the surface, behaviours and symptoms like lack of eye contact, limited reciprocity, and tantrums might cause one to confusingly overlap SM and ASD. However, these are considered as two distinct conditions and are unrelated. ASD is not simply limited to a lack of communication in specific social settings. If you have read the other articles discussing ASD in depth on our website, you would realize that ASD involves a range of neurodevelopmental disorders that includes symptoms such as repetitive movements, lack of understanding of social cues, impaired social functioning, and lack of empathy. In addition, individuals with ASD may vary widely in their level of functioning on a spectrum, meaning that there may be a huge contrast between the observed behaviors of two different children both diagnosed with ASD. Furthermore, these behaviors are exhibited consistently in all social settings unless these individuals have gone through some form of behavioral intervention. In contrast, the majority of individuals with SM behave in a socially appropriate manner in a comfortable environment, similar to other typically developing children.
By having a clear distinction between SM and ASD as mentioned above, parents would be able to get professional help for their kids depending on their diagnosis. While Applied Behavioral Analysis (ABA) therapy is considered to be the standard treatment for ASD (Slocum et al., 2014), Psychotherapy, Play, and Cognitive Behavioral therapy are highly encouraged for SM. Psychotherapy and Play therapy are deemed effective treatments since pressure for verbalization is removed. Instead, it would place emphasis on letting the individual with SM be in a relaxed environment and identify their cause of worries which slowly leads them to open up. Similarly, cognitive behavioral therapy aims to aid children by modifying their fears of speaking in specific situations into positive thoughts through further incorporation of awareness and acknowledgement of anxiety, building confidence to talk in social settings, and lowering anxiety levels (Manassis, 2009).
Nonetheless, SM remains a challenge for research to study as the majority of data and evidence are derived from case reports and small scale populations, which may not be able to provide a general picture and accurate representation of SM globally. As a result, it is problematic to truly grasp SM holistically. Hopefully, with the knowledge of both disorders, parents are able to better understand their child’s behaviors and differentiate between ASD and SM in order to procure the appropriate treatments.
Written by Hannah.
Citations
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Arlington, VA: Author.
Kovac, L. M., Kovac, L. M., Furr, J. M., & Furr, J. M. (2019). What teachers should know
about selective mutism in early childhood. Early Childhood Education Journal, 47(1),
107-114. doi:10.1007/s10643-018-0905-y
Manassis K. (2009). Silent suffering: understanding and treating children with selective
mutism. Expert review of neurotherapeutics, 9(2), 235–243.
Slocum, T. A., Detrich, R., Wilczynski, S. M., Spencer, T. D., Lewis, T., & Wolfe, K. (2014).
The Evidence-Based Practice of Applied Behavior Analysis. The Behavior analyst, 37(1), 41–56. https://doi.org/10.1007/s40614-014-0005-2